Lukas Schwentner1, Gisela Helms2, Valentina Nekljudova3, Beyhan Ataseven4, Ingo Bauerfeind5, Nina Ditsch6, Tanja Fehm7, Barbara Fleige8, Maik Hauschild9, J Heil10, Sherko Kümmel11, Anette Lebeau12, Sabine Schmatloch13, Peter Schrenk14, Anette Staebler15, Sibylle Loibl3, Michael Untch16, Gunter Von Minckwitz3, Cornelia Liedtke17, Thorsten Kühn18. 1. Department of Gynecology and Obstetrics, University Ulm, Prittwitzstraße 43, 89075 Ulm, Germany. 2. Department of Gynecology and Obstetrics, University Tübingen, Calwerstraße 7, 72076 Tübingen, Germany. 3. German Breast Group, Martin-Behaim-Straße 12, 63263 Neu-Isenburg, Germany. 4. Department of Gynecologic Oncology, Klinikum Essen-Mitte, Henricistraße 92, 45136 Essen, Germany. 5. Department of Gynecology and Obstetrics, Klinikum Landshut, Robert-Koch-Straße 1, 84034 Landshut, Germany. 6. Department of Gynecology and Obstetrics, University Munich, Marchionistraße 15, 81377 München, Germany. 7. Department of Gynecology and Obstetrics, University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany. 8. Department of Pathology, Helios Klinikum Berlin Buch, Schwanebecker Chaussee 50, 13125 Berlin, Germany. 9. Department of Gynecology and Obstetrics, Gesundheitszentrum Fricktal, Riburgerstraße 12, 4310 Rheinfelden, Switzerland. 10. Department of Gynecology and Obstetrics, University Heidelberg, Neuenheimer Feld 440, 69120 Heidelberg, Germany. 11. Department of Senology, Klinikum Essen-Mitte, Henricistraße 92, 45136 Essen, Germany. 12. Department of Pathology, University Hamburg, Martinistraße 42, 20246 Hamburg, Germany. 13. Breast Cancer Center, Elisabeth Krankenhausx, Weinbergstraße 7, 34117 Kassel, Germany. 14. Department of Surgery, AKH Linz, Krankenhausstraße 9, 4020 Linz, Austria. 15. Department of Pathology, University Tübingen, Liebermeisterstraße 8, 72076 Tübingen, Germany. 16. Department of Gynecology and Obstetrics, Helios Klinikum Berlin Buch, Schwanebecker Chaussee 50, 13125 Berlin, Germany. 17. Department of Gynecology and Obstetrics, University Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany. 18. Department of Gynecology and Obstetrics, Hospital Esslingen, Hirschlandstraße 97, 73730 Esslingen, Germany. Electronic address: t.kuehn@klinikum-esslingen.de.
Abstract
BACKGROUND: With the growing importance of neoadjuvant systemic therapy (NST) the assessment of post neoadjuvant axillary status is of increasing importance especially in patients who presented initially with suspicious nodes (cN1). This study aims to investigate the predictive value of palpation and axillary ultrasound of formerly cN1 patients following NST. PATIENTS AND METHODS: The SENTINA trial (SENTinel NeoAdjuvant) is a 4-arm prospective multicenter study designed to evaluate the role of sentinel node biopsy (SLNB) in the context of neoadjuvant systemic treatment (NST) of breast cancer patients. RESULTS: 1240 patients from 103 institutions entered the trial. 715 (arm C n = 592; arm D n = 123) patients, who presented initially cN1 underwent clinical evaluation of lymph node status following NST. Palpation alone demonstrated a sensitivity of 8.3%, specifity of 94.8% and a negative predictive value (NPV) of 46.6%. Ultrasound alone revealed a sensitivity of 23.9%, specificity 91.7%, and a NPV of 50.3%.The investigators combined classification (palpation and ultrasound) resulted in a sensitivity of 24.4%, specificity 91.4%, and a NPV of 50.3%. Investigators classified the axilla nodes as being unsuspicious (cN0) following NST in 592/715 patients; of them 298 (50.3%) were pN0, 151 (25.5%) had 1-2 histologically involved nodes and 143 (24.2%) had >2 histologically involved nodes. CONCLUSION: The diagnostic accuracy of ultrasound and palpation following NST is unacceptably low and additional tools for evaluation of the axillary lymph node status following NST are urgently needed.
BACKGROUND: With the growing importance of neoadjuvant systemic therapy (NST) the assessment of post neoadjuvant axillary status is of increasing importance especially in patients who presented initially with suspicious nodes (cN1). This study aims to investigate the predictive value of palpation and axillary ultrasound of formerly cN1patients following NST. PATIENTS AND METHODS: The SENTINA trial (SENTinel NeoAdjuvant) is a 4-arm prospective multicenter study designed to evaluate the role of sentinel node biopsy (SLNB) in the context of neoadjuvant systemic treatment (NST) of breast cancerpatients. RESULTS: 1240 patients from 103 institutions entered the trial. 715 (arm C n = 592; arm D n = 123) patients, who presented initially cN1 underwent clinical evaluation of lymph node status following NST. Palpation alone demonstrated a sensitivity of 8.3%, specifity of 94.8% and a negative predictive value (NPV) of 46.6%. Ultrasound alone revealed a sensitivity of 23.9%, specificity 91.7%, and a NPV of 50.3%.The investigators combined classification (palpation and ultrasound) resulted in a sensitivity of 24.4%, specificity 91.4%, and a NPV of 50.3%. Investigators classified the axilla nodes as being unsuspicious (cN0) following NST in 592/715 patients; of them 298 (50.3%) were pN0, 151 (25.5%) had 1-2 histologically involved nodes and 143 (24.2%) had >2 histologically involved nodes. CONCLUSION: The diagnostic accuracy of ultrasound and palpation following NST is unacceptably low and additional tools for evaluation of the axillary lymph node status following NST are urgently needed.
Authors: Abigail S Caudle; Henry M Kuerer; Savitri Krishnamurthy; Kyungmin Shin; Brian P Hobbs; Junsheng Ma; Elizabeth A Mittendorf; Ashley C Washington; Sarah M DeSnyder; Dalliah M Black; Kelly K Hunt; Wei T Yang Journal: Cancer Date: 2018-10-25 Impact factor: 6.860
Authors: Abigail S Caudle; Isabelle Bedrosian; Denái R Milton; Sarah M DeSnyder; Henry M Kuerer; Kelly K Hunt; Elizabeth A Mittendorf Journal: Ann Surg Oncol Date: 2017-08-01 Impact factor: 5.344
Authors: Won Hwa Kim; Sang-Woo Lee; Hye Jung Kim; Yee Soo Chae; Shin Young Jeong; Jin Hyang Jung; Ho Yong Park; Won Kee Lee Journal: Sci Rep Date: 2018-02-16 Impact factor: 4.379
Authors: R Sarin; S P Somsekhar; R Kumar; Gupta Pawan; Jain Sumeet; Jindal Pramoj; Zamre Vaishali; Pasha Firoz; P M Parikh; S Aggarwal; R Koul Journal: South Asian J Cancer Date: 2018 Apr-Jun
Authors: Signe Borgquist; Lisa Rydén; Ida Skarping; Daniel Förnvik; Sophia Zackrisson Journal: Breast Cancer Res Treat Date: 2021-06-12 Impact factor: 4.872